Homeopathy Repertory

A Homoeopathic View of Dysmenorrhoea by Cross Repertorisation

Dysmenorrhoea

Drs. Rajeev Saxena, Sonal Sinha, Pooja Jain and Seema Gupta use cross repertorization to identify high probability remedies for dysmenorrhea. The repertories of Boericke, Murphy, Phatak, Clarke, Kent and Schroyens’ Synthesis were consulted.

Abstract:  Dysmenorrhoea is the most common gynecologic complaint and the leading cause of recurrent short-term school or work absenteeism among female adolescents and young adults.  It is defined as difficult menstrual flow or painful  menstruation  of  uterine  origin  and  commonly  divided  into  two  categories  based  on  the  pathophysiology  which  is  primary  and  secondary.  Primary dysmenorrhea  typically begins during  adolescence ith  ovulatory  cycles  and  is  not  due  to  any  pelvic  disease.  It is distinguished from secondary dysmenorrhea, which is  uncommon  during  adolescence  and  results  from  pelvic  organ  pathology.  This  is  an  article  about dysmenorrhoea  focusing  on  classification,  etiology,  clinical  type  and homoeopathic  medicines related  to  various  rubrics  in  different  repertories  by  cross  repertorisation.

Keywords:  Dysmenorrhoea – primary & secondary, Homoeopathy, Cross-repertorisation, Therapeutic medicines.

Introduction:  Normal  menstrual cycles  are   often  associated with difficult and painful  menstruation  known as  dysmenorrhoea. The  term  dysmenorrhoea   is  derived  from  the Greek  words  Dys-  meaning  difficult/  painful/  abnormal,  meno-  meaning  month,  and  rrhea  meaning  flow.(1)  It  may  affect  more  than  50%  of  menstruating  women,  and  its  reported  prevalence  has  been  highly  variable  (e.g. 45-95%).  Optimal management of this symptom  depends  on  an understanding  of  the  underlying  cause.(2)

 

Classification:  There  are  two  types  of  dysmenorrhoea:

  1. A) Primary/ Idiopathic/  True  dysmenorrhoea:  The  pain  is  of  uterine  origin  and  directly  linked  to  menstruation  but  with  no  visible  pelvic    Pain usually  occurs  on  the  first  day  (Spasmodic  dysmenorrhoea).(3)  It  typically  occurs  in   the  first  few  years  after  menarche  and  affects  as  many as  50%  of  postpubertal  females. (2)
  2. B) Secondary dysmenorrhoea:  Pain  which  is  associated  with  uterine  /  pelvic  pathology(3),  as  is  seen  in  women  with  endometriosis  or  chronic  pelvic  inflammatory    It is  most  often  observed  in  women  aged  30-45  years(2).  It  may  continue  throughout  the  flow/ congestive,  i.e.  worse premenstrually  and  relieved  during  flow. (3)

 

Etiology:

Risk  factors  for  primary  dysmenorrhoea  include  the  following:

  • Early age  at  menarche  (< 12 years)
  • Nulliparity
  • Heavy or  prolonged  menstrual  flow
  • Smoking
  • Positive family  history
  • Obesity(2)

 

Risk  factors  for  secondary  dysmenorrhoea  include  the  following :

Excess  prostaglandin  production  or  hypertonic  uterine  contractions  secondary to  cervical  obstruction,  intrauterine  mass  or  pressure  of  foreign  body.  A definitive  cause  can  be  found.  The most  common  causes  are:

  • Imperforate hymen
  • Transverse vaginal  septum
  • Cervical stenosis
  • Uterine anomalies
  • Intrauterine synechiae
  • Endometrial polyps
  • Intrauterine devices
  • Uterine leiomyomas
  • Adenomyosis
  • Pelvic congestion  syndrome(3)
  • Leiomyomata (fibroids)
  • PID
  • Tubo-ovarian abscess
  • Ovarian torsion
  • Endometriosis(2)

 

Clinical  features:

Primary  dysmenorrhoea

Clinical  features  of  primary  dysmenorrhea  include  the  following:

  • Pain begins  a  few  hours  or  just  after  the  onset  of  menstrual  period  and  may  last  up  to  48-72
  • Suprapubic cramping  lumbosacral  backache,  pain  radiating  down  to        anterior  aspect  of
  • Colicky in  (3)

Signs-                                                                                                                  

  • Normal vital
  • No abdominal
  • Normal pelvic  (3)

Secondary  Dysmenorrhoea:

The  following  may  indicate  secondary  dysmenorrhea :

  • Dysmenorrhoea beginning  in  the  20s  or  30s,  after  previous  relatively  painless cycles
  • Heavy menstrual  flow  or  irregular bleeding
  • Dysmenorrhoea occurring  during  the  first  or  second  cycles  after  menarche
  • Pelvic abnormality  with  physical  examination
  • Poor response  to  nonsteroidal  anti- inflammatory  drugs (NSAIDs)  or  oral contraceptives (OCs)
  • Infertility
  • Dyspareunia
  • Vaginal discharge.(2)

Cross Repertorization:

Selection  of  repertory  for  repertorization  mainly  depends  on  the  type  of  the  case.  A  physician  generally  limits  himself  to  one  repertory  while  working out  a  case.  Cross- repertorization  using more  than  one  repertory  is  for selection  of  the simillimum or to confirm  the  result obtained from the use  of one repertory.  Here, cross repertorisation of the rubrics related to dysmenorrhoea from various repertories is done to identify likely homoeopathic medicines. (4) The rubrics regarding dysmenorrhea  from  different  repertories  are  as  follows:-

 

Boericke’s  repertory:

DYSMENORRHOEA, Remedies in general (766): Apiol., Bell., Borx., Cact., Caul., Cham., Cimic., Cocc., Coff., Coloc., Gels., Gnaph., Guaj., Ham., Kali- perm., Macrot., Mag-c., Mag-p., Puls., Sec., Senec., Verat., Vib., Xan., Zinc. (5)

Clarke repertory:

Dysmenia, or Dysmenorrhoea.(57): Aco., Aga., Alet., Ana., Atp., Aran., Art.v., Asr., Asc.s., Ber., Brac., Bro., Cast., Caul., Cer.o., Cham., Ch.s., Chl. h., Coll., Col., Cro., Crt. h., Cur., Dio., Gel., Gna., Gos., Gph., Gui., Haem., Hdm., Hlon., Hyo., Ign., Inu., Iris., Jab., Jn. c., K. ca., K. fc., K. n., Klm., Lc. c., Lc. f., Lp. s., Lau., Lo. i., Lyc., Mac., Mag. m., Mag. p., Mag. s., Man., Med., Mli., Mrl., Mil., Mit., Mom., Mur., Naj., Na. c., Nic., Nx. m., Opi., Pet., Phyt., Plat., Pb., Pod., Plg., Pop. c., Pul., Rap., Rhs., Sbl., Sbi., Sang., Sap., Sars., Se. a., Sep., Sul., Syph., Tan., Trn., Ter., Ther., Thu., Thyr., Tur., Ust., Ver., Ve. v., Vb. o., Vb. p., Wye., Xan. (6)     

Kent  repertory:

GENITALIA- FEMALE- MENSES- painful, dysmenorrhoea: acon., am-c., ars., Bell., berb., bor., Cact., calc., Calc-p., caul., caust., Cham., cic., Cimic., cocc., coff., coloc., con., croc., cycl., dios., dulc., gel., graph., helon., ign., kali-ar., Kali-c., kali-i., kali-p., kali-s., lac-c., lach., lap-a., lil-t., lyc., med., meli., merc., merl., nat-c., nux-v., phos., plat., Psor., puls. , rhus-t., sabin., sec., senec., sep., sulph., tub., verat., xan. (7)

Murphy repertory:

DYSMENORRHOEA, painful menses (765): AM-C., BELL., CACT., CACL-P., CHAM., CIMIC., COCC., COLOC., CYCL.,ERIG., IGN., KALI-C., MAG-P., MILL., NUX-V., PSOR., PULS., SABIN., SEP., SULPH., UST., VERAT-V., VIB., XAN. (8)

Phatak repertory:  

MENSES – Painful, dysmenorrhoea(263): Bell; Cact; Calc; Calc-p; Caul; CHAM., Cimi; Cocl; Con; Cup; Dios; Grap; Kali-c; Lyc; Med; Nux-m; Plat; PUL; Psor; Sep; SUL; Tub; Ver-a; VIB; Xanth; Zin-val. (9)

Synthesis repertory:

Female  genitalia/ sex- Menses- painful: ( pain; Pain- uterus – menses – during – agg.) (1132): Am-c,  Bell,  Cact,  Calc-p,  Cham,  Cimic,  Cocc,  Erig, Kali-c, Mag-p, Mill,  Psor,  Ust,  Verat-v,  Vib,  Xan. (10)

Repertorial  result:

Based  on  the  above  given  rubrics  of  dysmenorrhea  from  different  repertories.

  1. Chamomilla 6 (15)
  2. Xantoxylum Fraxineum 6 (12)
  3. Cimicifuga Racemosa 5 (14)
  4. Viburnum Opulus 5 (12)
  5. Belladonna 5 (12)
  6. Kalium Carbonicum 5 (11)
  7. Pulsatilla Pratensis 5 (11)
  8. Cocculus Indicus 4 (10)
  9. .Magnesia  Phosphorica  4 (10)

Therapeutics  of  Dysmenorrhoea:

Chamomilla – Dysmenorrhoea from anger or emotions. membranous dysmenorrhea,  especially  at  puberty.  Profuse  discharge  of  clotted , dark  blood with  labor  like  pains.  Menstrual  cramps  with  a  lot  of  pain  and  irritability. Patient  intolerant  of  pain. Yellow,  acrid  leucorrhea. (11)(12)

 

Xantoxylum  Fraxineum – Menses too early and painful. neuralgic dysmenorrhoea  with  neuralgic  headaches, ovarian neuralgia with pain in the loins  and  lower  abdomen; worse, left  side, extending  down  the  thigh , along  the genito-crural  nerves . Pain in the back and down the legs. Menses thick, almost black. After- pains.  Leucorrhoea  at  time  of  menses.(11)(12)

 

Cimicifuga  Racemosa  – Menses  profuse, dark, coagulated, offensive with  backache, nervousness , irregular in time and amount, more  flow, more pain menses  suppressed  from  menses.  Hysteric  or  epileptic  spasms at  the  time of  menses. Great  debility  between menses. Pain  across  the  pelvis,  from  hip  to  hip. After- pains  with  great sensitiveness and  intolerance  to  pain. Infra-mammary pains, worse  left side. Pain  in   the  ovarian region ; shoots upward  and  down  the  anterior  surface  of  thighs. Pain  immediately  before  menses.(11)(12)

 

Viburnum  Opulus– Sudden  pain  in  the  region  of  uterus  before  menstruation and much backache during menses. offensive  in  odor, with  crampy  pains, cramps  extend  down  the  thighs. Bearing  down  pains  before  menses.  Ovarian region  feels  heavy and  congested  (ovaritis ) aching  in sacrum  and  pubes, with  pain  in  anterior  muscles  of  thighs; spasmodic and membranous dysmenorrhea. Leucorrhea  excoriating.  Smarting  and  itching  of  genitals. Faints  on  attempting  to  sit  up. (11)(12)

 

Belladonna- Menses  bright  red,  too  early , too profuse . Menses  and  lochia  very  offensive  and  hot.  Cutting  pain   from  hip  to  hip. Ovarian  pain  with appearance  of  menses. Flow  of  blood  between  periods. Dragging  around  loins.  badly  smelling  haemorrhages, hot  gushes  of  blood.  Diminished  lochia. (11)

 

Kalium  Carbonicum –  Menses  early , profuse, or  too late  pale  and  scanty,  with  soreness  around  the  genitals; pain  from  the  back  passes  down,  through  the  gluteal  muscles,  with  cutting   in  the  abdomen. Pain  through  the  left  labium, extending  through  the  abdomen  to  the chest. Difficult  first  menses. Complaints  after  parturition. Uterine  hemorrhage;  constant  oozing  after  copious  flow,  with  violent  backache (dysmenorrhea ),  relieved  by  sitting  and  pressure. (11)

 

Pulsatilla – Dysmenorrhoea beginning in puberty. Dysmenorrhoea, with chilliness, paleness of face, stretching and yawing. During menses, fainting, nausea and vomiting,  sour  slimy  taste. Chilliness, nausea  with  a  downward  pressure   and pain, tardy menses. Flow intermits. Diarrhea  during  or  after menses. Uterine cramps,  compelling  her  to  bend  double.(11)(12)

 

Cocculus Indicus  – Dysmenorrhoea,  with  profuse  dark  menses.  Menses too early, clotted, with spasmodic colic. Painful pressing in  the  uterine  region, followed  by  hemorrhoids.  Purulent, gushing  leucorrhea   between  menses;  very  weakening. Can scarcely  speak. So  weak  during  menstruation, she  is  scarcely  able  to  stand. (11)(12)

 

Magnesia Phosphorica –   Menstrual  colic , pain  precedes  flow,  membranous  dysmenorrhea. Menses too early, dark,  stringy.  Swelling  of  external  parts.  Ovarian  neuralgia.  Vaginismus.   <  on  right  side,  >  by  external  application  of heat.(11)

 

Conclusion: The above medicines are used frequently in daily practice for dysmenorrhoea  with  good  results.  These are only the top most remedies found  through  cross  repertorisation,  but  other  homoeopathic  medicines  can also  be  used  for significant  relief   in  dysmenorrhoea.

 

References:

  1. Study of the Prevalence and Severity of Dysmenorrhoea Among the University Students of Hail City http://www.ijhsr.org/IJHSR_Vol.3_Issue.10_Oct2013/3.pdf
  2. Medscape https://emedicine.medscape.com/article/253812-overview#a1
  3. Salhan Sudha. Textbook of Gynecology. First edition. New  Delhi: Jaypee Brothers Medical  Publisher(p)  2011. Page no. 98, 99.
  4. Tiwari SK. Essentials  of  repertorization, fifth edition, 2012, B jain publisher    Ltd. page no. 513
  5. Boericke   Boericke’s   New  Manual  Of   Homoeopathic  Materia  Medica  With  Repertory.  New  delhi: B.  Jain  Publisher  Pvt.  Ltd.  Third  revised  &  augmented  edition, 2008. Page no. 766.
  6. Clarke JH. A clinical  repertory  to  the  dictionary  of  materia  New Delhi:B Jain Publisher: Edition; 2007 page no.- 57
  7. Kent T.  Repertory  of  the  Homoeopathic  Materia  Medica.  New  Delhi: B.  Jain  Publisher  Pvt.  Ltd.  First   indian  edition,  1991.  Page no. 727.
  8. Murphy   Homoeopathic  medical  Repertory.  New Delhi: B.jain publisher:  second  revised  edition, 2006. Page no. 765
  9. Phatak SR. A Concise Repertory  Of  Homoeopathic  Fourth edition,  2005,  B jain  publisher  pvt. Ltd. page no. 263
  10. Schroyens  synthesis (Repertorium  Homoeopathicum  Syntheticum). New Delhi: B. Jain  publisher,  edition 9.1, 2014  page no. 1132
  11. Boericke W. New Manual Of Homoeopathic Materia Medica & Repertory. New  delhi: B. Jain  publisher, third  revised  &  augmented  edition, 2008 page  102, 167, 181, 193, 326, 371, 477, 596.
  12. Murphy R. Lotus materia  Third  Indian  edition,  New  Delhi, B. Jain  publisher  pvt.  Ltd. 2010. Page no. 321, 513, 573, 1046, 1599, 2056.

About the author

Rajeev Saxena

Rajeev Saxena

Prof. Dr. Rajeev Saxena is a senior homoeopathic physician practicing homoeopathy for 25 years. He completed his Bachelor and Masters in Homoeopathic Science from the University of Rajasthan, Jaipur and did his masters in Repertory. For the last 17 years he has worked as Professor, HoD, PG and PhD guide in the Department of Repertory at S. K. Homoeopathic Medical College and Research Centre, Jaipur. He has tremendous enthusiasm and passion for homoeopathy, more especially studying the repertory keenly and in great detail. He participated in various seminars, workshops and conferences related to homoeopathy and repertory. He has been awarded and honored in the field of health, homoeopathy and social services by various foundations and institutions.

About the author

Sonal Sinha

Sonal Sinha

Dr. Sonal Sinha - BHMS, PGNAHI, (Nagpur) MD (PGR), Repertory from Swasthya Kalyan Homoeopathic Medical College, Jaipur Rajasthan, India. CGO, CCH (Maharastra). Dr. Sinha is a member of LMHI.

About the author

Pooja Jain

Pooja Jain

Dr. Pooja Jain, MD (PGR), Repertory, Swasthya Kalyan Homoeopathic Medical College and Research Centre, Jaipur, India.

About the author

Seema Gupta

Seema Gupta

MD (PGR), Repertory, Swasthya Kalyan Homoeopathic Medical College and Research Centre, Jaipur, Rajasthan, India.

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